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• W1566588228 abstract "Sirs, Tack and colleagues should be praised for demonstrating in this Phase II proof of concept double-blinded clinical trial that a non-absorbable carbon compound (AST-120) was suitable to relieve symptoms in nonconstipating irritable bowel Syndrome (IBS).1 This study revealed a remarkable reduction in their primary endpoints of abdominal pain, along with other secondary endpoints that reached statistical significance. Thus, a medication with a nonsystemic effect significantly relieves IBS symptoms. Acting on the luminal side, without any appreciable systemic effect might be particularly important for the treatment of a condition that does not have any disease-associated mortality, and thus requires very safe treatment options. If treatment targets the luminal side, symptoms associated with fermentable oligo-, di- and mono-saccharides and polyols (FODMAP) need to be considered, and this holds true in particular for patients with nonconstipating irritable bowel syndrome. Dietary restriction of FODMAP is a very effective and evidence-based approach for global symptom reduction,2 and such a measure might be preferred since no medication is required. In the context of this study it would have been at least desirable to try an elimination diet before patients were recruited, or at least control for FODMAP intake. As another potentially confounding factor, loperamide was permitted to be used as a rescue therapy for participants experiencing frequent diarrhoea. The authors did not adjust for loperamide use. It is well recognised that loperamide, while controlling diarrhoea, may cause other GI symptoms. This may also have resulted in an overestimation of the efficacy of the carbon product. Clinical efficacy of AST-120 may also be time limited, as statistical differences in primary and secondary endpoints were no longer observed at week 8 due to a rising response in the placebo group, or in other words a spontaneous remission. Thus, this treatment actually may not alter the long-term course of symptoms. Despite the aforementioned limitations, this study suggests short-term improvements of specific symptoms. However, the data also suggest, that there continues to be a need for treatments that actually change the natural course and have long-lasting effects on IBS symptoms. Declaration of personal and funding interests: None." @default.
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• W1566588228 date "2011-12-09" @default.
• W1566588228 modified "2023-09-24" @default.
• W1566588228 title "Carbon-based compounds emerging as sparkling diamonds for IBS treatment?" @default.
• W1566588228 cites W1518078422 @default.
• W1566588228 cites W2155620449 @default.
• W1566588228 doi "https://doi.org/10.1111/j.1365-2036.2011.04893.x" @default.
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